Department of Orthopaedic Surgery, Nippon Medical School Musashikosugi Hospital.
Department of Infection Control and Prevention, Nippon Medical School Musashikosugi Hospital.
J Nippon Med Sch. 2022;89(3):347-354. doi: 10.1272/jnms.JNMS.2022_89-110.
Mycobacterium abscessus infection of the upper extremities is uncommon. However, M abscessus can cause severe chronic tenosynovitis, and delayed diagnosis may result in poor outcomes. We describe an unusual clinical case of purulent flexor tendon synovitis followed by subcutaneous tendon rupture due to M abscessus infection in a patient with diabetes mellitus. A 76-year-old man presented to our hospital with painful, erythematous swelling over his left fourth finger. On physical examination, the left fourth finger was swollen and reddish, with persistent exudate from the surgical scar. The left elbow was also swollen and reddish with persistent discharge, which was consistent with olecranon bursitis. The patient was unable to flex his left fourth finger, and the passive range of motion of the finger was also restricted. The physical examination findings and patient history suggested purulent flexor tendinitis. His infection healed after radical debridement of necrotic tissue and administration of antibiotics effective against M abscessus. Third-stage flexor reconstruction restored the function of the fourth finger. The combination of surgical debridement and chemotherapy was the most effective treatment for mycobacterial tenosynovitis. This case shows that M abscessus can cause chronic severe purulent tenosynovitis and flexor tendon rupture after tendon surgery. Although early diagnosis and combination treatment with debridement and chemotherapy might improve outcomes by limiting the severity and duration of damage to the flexor synovial system, late-presenting patients require combined radical debridement of necrotic tissue and aggressive chemotherapy followed by staged flexor tendon reconstruction.
上肢分枝杆菌脓肿感染并不常见。然而，脓肿分枝杆菌可引起严重的慢性腱鞘炎，如果诊断延迟可能导致不良结局。我们描述了一例糖尿病患者因脓肿分枝杆菌感染引起化脓性屈肌腱滑膜炎和随后的皮下肌腱断裂的不常见临床病例。一名 76 岁男性因左第四指疼痛、红肿、伴有手术瘢痕持续渗出而就诊于我院。体格检查发现左第四指肿胀、发红，左肘也肿胀、发红，伴有持续渗液，符合鹰嘴滑囊炎。患者无法弯曲左第四指，手指的被动活动范围也受限。体格检查结果和患者病史提示化脓性屈肌腱炎。在彻底清创坏死组织和使用针对脓肿分枝杆菌有效的抗生素后，患者感染得到治愈。第三阶段屈肌重建恢复了第四指的功能。手术清创和化疗的联合是治疗分枝杆菌腱鞘炎最有效的方法。本病例表明，脓肿分枝杆菌可导致肌腱手术后慢性严重化脓性腱鞘炎和屈肌腱断裂。尽管早期诊断和清创与化疗联合治疗可以通过限制屈肌滑膜系统损伤的严重程度和持续时间来改善结局，但晚期就诊的患者需要在进行彻底清创坏死组织和积极化疗后，分阶段进行屈肌腱重建。
